Hidradenitis suppurativa:From pathogenesis to emerging treatment options

Hidradenitis suppurativa (HS) is a chronic skin disease that is characterized by inflammation of the hair follicles. The cause of HS is largely unknown and the disease remains difficult to treat. Mrs. Janine Dickinson-Blok studied the pathogenesis of HS and the efficacy of existing and emerging therapies. In the first part of her thesis she focused on the pathogenesis of HS. She demonstrated that fragility of hair follicles is not a hallmark of HS, as was previously described by others. She did find that a specific protein called integrine α6β4 is highly present at the sebaceous glands of HS patients. This protein may contribute to activation of the immune system and consequently to an exacerbation of the disease. Additionally, she described that patients with Down syndrome possibly have a functional deficiency of an enzyme called gamma-secretase. This could raise the risk for the development of HS in this patient group. The second part focused on treatment of HS. Based on a systematic review she concluded that the use of specific inhibitors of the immune system, so-called TNF-α inhibitors, is the best medical treatment of HS to date. Furthermore, she showed that ustekinumab (an immune therapy drug) is effective in the majority of a group HS patients. Additionally, she described a new surgical technique for moderate to severe HS (the Skin Tissue sparing Excision with Electrosurgical Peeling procedure). Finally, she concluded that in most cases the combination of surgery with systemic agents is mandatory in order to prevent new inflammatory lesions